Provider Demographics
NPI:1679225536
Name:DYNAMIC PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:DYNAMIC PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HANS
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:801-349-2480
Mailing Address - Street 1:1654 W REUNION AVE STE 10B
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-4676
Mailing Address - Country:US
Mailing Address - Phone:801-349-2480
Mailing Address - Fax:801-363-4885
Practice Address - Street 1:1654 W REUNION AVE STE 10B
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-4676
Practice Address - Country:US
Practice Address - Phone:406-404-6815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-21
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty